I was so lucky to be chosen as one of the two exchange students who could spend two months observing at Cincinnati Children’s hospital medical center. This is my greatest honor and the most unforgettable experience in my life.
I’d like to write down my sees and thoughts-not just what’s in Cincinnati, also before it- which is a comparison between Chinese medical affairs and that of America.
First of all, please allow me to give you a general idea of where I am standing. In China, I’m in my last year of 7-year-program of Clinical Medicine (Pediatrics) in Chongqing Medical University, and rotating as an intern in different departments of Children’s Hospital of our University; While in CCHMC, I was an observer spending one month in Rehab Department (half day in ward and half day in clinic) and three weeks in Pulmonary Department (one week in Main Pulm, one week in TCC and the last week in clinic and OR). I followed fellows and attendings mostly in Rehab team; while in Pulmonary Department, I spent most of my time with residents, especially the interns. I also attended the orientation of third year medical students before the second month, which I think helped me a lot.
Hospital for children
My primary impression is that CCHMC is a real paradise for children. Every detail reminded me I was a pediatrician in a children’s hospital. The decoration and furnishing is so child-friendly and family-friendly. Staffs are guardians for children. When in Rehab team, I was required to wear daily dress instead of white coat, which is believed to cause fear of children. Almost every doctor has his secret weapon to make his little friends happy: jokes, funny faces, funny voice, stickers, toys… they are so patient with children, even though meeting with “little devils”, they listen to them, treat them with respect and have magic to make them calm and gentle.
Child life, which is a new concept for me, gave me a shock. I’ve never thought that children’s need could be a certain subject and was so seriously dealt with.
Now I’ve work several days back our Children’s hospital, and I feel I am more patient and friendly to children, understand them more, and more enjoy time with them.
What impresses me most is the Pediatric Residency Program in CCHMC. Compared of residents in China, residents in CCHMC are more like learners rather than workers. They have so much learning resources and opportunity: in the morning reports, they can share and analyze real cases from different departments; in the noon conferences, their appetite as well as the thirst for knowledge are fed at the same time; the grand rounds broaden their horizon; the center link and the Pratt library provide them abundant information; there are also bewildering lectures, trainings, journal clubs conducted by fellows and attendings. However, residents in China are more like employees of hospitals. They are tired of finishing routine jobs and lack of time and vigor to learn. Luckily our children’s hospital has more learning resources, like lectures, teaching rounds, research programs than other hospitals do and encourages residents to go on study. With this experience, I will cherish these opportunities more rather than regarding them as additional burden.
Residents in CCHMC are also of more independent mind. In the rounds, they speak more, especially the assessments and plans, which provide great opportunity for them to develop clinical thinking and decision making ability. While in our hospital, the attending play a leading role in rounds. After the residents update them on patients, they analyze, make diagnosis and give plans. Residents just write down and carry out what they have said-it is a way of learning, especially for beginners, but after getting used of this model, it’s easy for residents to be lazy-minded. So I will try to make assessments and plans in my mind, compare them with attendings’, and learn from the differences between them.
Residents in CCHMC work so hard. They get up and visit patients so early in the morning and have no noon break. Ours work time is 8:00-12:00 and 2:00-5:00. Even so, some of us are complaining of being worn-out. Having seen this, I won’t be one of them.
Division and cooperation
As Cincinnati Children’s is a better developed hospital in a better developed country, it is not hard to understand that hospital staff’s work is much more specific than ours which require more communication. In Cincinnati Children’s, there are so many kinds of positions: doctor, nurse (RN, APN, health care manager..), nursing worker, pharmacist, therapist (PT, OT, speech therapist, respiratory therapist, music therapist…), social worker, technician, nutritionist, child life specialist, interpreter, assistant, et al. what’s more, they communicate a lot and work as a team. In some of the rehab clinics, a team of different staffs visit patients together, which I think provide better service and great convenience for patients. While in Chinese hospitals, doctors and nurses-the two main forces -may play multiple roles. It may be a little hard to believe for you, almost every Chinese clinic doctor works as a team: without help of check-ins and nurses, he or she may visit more than one hundred patients a day.
I cannot change the circumstance but myself. A teacher told me a sentence, “Know one thing of everything, and know everything of one thing”. We have to know one thing of everything which is a requirement for a Chinese doctor. However, I’ll also try to be a specialist in a certain field and know everything of it, like Uncle Reggie’s motto “focus, focus, focus”.
Cincinnati ChiIdren’s also show me a great model of family-centered care, which I had only learned in the book. I was taught that parents should be partners of health care team and take part in decision making. However, it’s too idealized in the current circumstances of China. It’s like that if a man is solving problems of eating and wearing, it is a little bit luxury for him to think of the need of higher level. Most of the time, we could only treat disease rather than patients, especially when facing with the influx of patients, we must relieve their illness as soon as possible. Parents’ education level is another obstacle. Sometimes we encourage parents to involve in decision making only to get their antipathy and distrust. They said “are you shirking your responsibility? I’m not the doctor. I pay, you treat.” I know it’s not anybody’s fault, just a matter of time. Thanks for having the opportunity to see the bright possibility ahead- parents and doctors can work hand in hand. Now I have faith we’ll get there someday.
Something may help for the next batch of exchange students
As one of the first batch of exchange students between UC and Chongqing Medical University, my another mission is to help my juniors as well as similar foreign observers in order to have a better experience in CCHMC. My suggests are as follows:
1. They’d better attend the orientation for the 3rd year medical students right before observation in hospital, so they can begin their observation at July, November or any other appropriate time.
2. Medical English is my main limitation at the beginning of observation. Speaking is harder than listening for me. So I suggest them strengthen their medical English as early as possible.
3. They’d better choose familiar departments to observe in, especially which their supervisor is in and they are doing research in. This can provide topics of communication and opportunity to learn from comparison.
4. They’d better offered introduction of CCHMC (I spent so long before I understood what do the badges of different colors and abbreviations mean; the work flow of ward and clinic ;...) and some learning material of the department they’ll observe in ahead before arriving CCHMC. I’ll help them with the orientation as well of course.
At last, I’d like to thank all those who helped me in this fantastic experience: Dr. Strauss, Uncle Reggie, Uncle James, Dr. Filak, Dr. Boat, Dr. Lehmann, Dr. Liming Bao, Dr. McMahon, Dr. Michaud, Dr. Kinnett, Dr. Jilda, Dr. Kurowski, Dr. Holman, Dr. Pruitt, Dr. McPhail, Dr. Ehsan, Dr. Gurbani, Dr. Siracusa, Dr. Simkajornboon, Dr. Wood, Dr. Clancy, Dr. McDowell, Dr. Matt Carroll, Dear Lala, Laura, Jessi, Ashlee… in Rehab team, Dear Christian, Joseph, Corni, Cristal, Page,… in Pulm team. Mrs. Liliana Ballesteros, Mrs. Eileen Mok, Mrs. Sue Simmons, Mrs. Donna Bridges, Mrs. Karen Christian, Mrs. Mimi Pence, Mrs. Clare Douglas…and all those who gave me a hand but didn’t leave their name for me. Thanks! Everyone I met with in Cincinnati is so friendly and ready to offer me a help, which left a quite splendid memory for me.